The role of aspirin as antiaggregant therapy in primary prevention. An update

Area of Science:

• Cardiology
• Preventive Medicine
• Clinical Trials

Background:

• Aspirin's use in primary prevention has been debated due to recent trials yielding neutral outcomes.
• The balance between cardiovascular benefits and bleeding risks is a key concern.

Purpose of the Study:

• To review recent major trials (ASCEND, ARRIVE, ASPREE) on aspirin for primary prevention.
• To analyze the benefit-risk profile of aspirin, focusing on cardiovascular events and bleeding.
• To establish aspirin's current position in primary prevention based on the latest evidence.

Main Methods:

• Detailed analysis of three key clinical trials: ASCEND, ARRIVE, and ASPREE.
• Inclusion of a recent meta-analysis encompassing these and other trials from the past 30 years.
• Evaluation of aspirin's efficacy in reducing cardiovascular events versus its risk of adverse bleeding events.

Main Results:

• ASCEND, ARRIVE, and ASPREE trials provide crucial data on aspirin's efficacy and safety in diverse populations.
• Analysis indicates that for the general population with moderate cardiovascular risk, diabetics, and the elderly, the risk of bleeding may offset the benefits.
• Recent meta-analyses reinforce the nuanced role of aspirin in primary prevention, highlighting specific patient subgroups.

Conclusions:

• Aspirin's indication in primary prevention requires careful consideration of individual patient profiles.
• The evidence suggests a diminished role for aspirin in primary prevention for many, particularly when bleeding risk is elevated.
• Further research and updated guidelines are necessary to refine aspirin's use in preventing cardiovascular events.